HF 4378

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/23/2022 12:33pm

A bill for an act
relating to behavioral health; modifying requirements for children's therapeutic
services and supports and certified community behavioral health clinics; amending
Minnesota Statutes 2020, section 245A.03, subdivision 2; Minnesota Statutes 2021
Supplement, section 256B.0625, subdivision 5m; proposing coding for new law
in Minnesota Statutes, chapter 245I; repealing Minnesota Statutes 2020, section
256B.0943, subdivisions 8, 8a, 10, 12, 13; Minnesota Statutes 2021 Supplement,
sections 245.735, subdivisions 3, 5, 6; 256B.0943, subdivisions 1, 2, 3, 4, 5, 5a,
6, 7, 9, 11.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2020, section 245A.03, subdivision 2, is amended to read:

Subd. 2.

Exclusion from licensure.

(a) This chapter does not apply to:

(1) residential or nonresidential programs that are provided to a person by an individual
who is related unless the residential program is a child foster care placement made by a
local social services agency or a licensed child-placing agency, except as provided in
subdivision 2a;

(2) nonresidential programs that are provided by an unrelated individual to persons from
a single related family;

(3) residential or nonresidential programs that are provided to adults who do not misuse
substances or have a substance use disorder, a mental illness, a developmental disability, a
functional impairment, or a physical disability new text begin , except that certified community behavioral
health clinics under section 245I.30 and children's therapeutic services and supports providers
under section 245I.40 are subject to this chapter new text end ;

(4) sheltered workshops or work activity programs that are certified by the commissioner
of employment and economic development;

(5) programs operated by a public school for children 33 months or older;

(6) nonresidential programs primarily for children that provide care or supervision for
periods of less than three hours a day while the child's parent or legal guardian is in the
same building as the nonresidential program or present within another building that is
directly contiguous to the building in which the nonresidential program is located;

(7) nursing homes or hospitals licensed by the commissioner of health except as specified
under section 245A.02;

(8) board and lodge facilities licensed by the commissioner of health that do not provide
children's residential services under Minnesota Rules, chapter 2960, mental health or chemical
dependency treatment;

(9) homes providing programs for persons placed by a county or a licensed agency for
legal adoption, unless the adoption is not completed within two years;

(10) programs licensed by the commissioner of corrections;

(11) recreation programs for children or adults that are operated or approved by a park
and recreation board whose primary purpose is to provide social and recreational activities;

(12) programs operated by a school as defined in section 120A.22, subdivision 4; YMCA
as defined in section 315.44; YWCA as defined in section 315.44; or JCC as defined in
section 315.51, whose primary purpose is to provide child care or services to school-age
children;

(13) Head Start nonresidential programs which operate for less than 45 days in each
calendar year;

(14) noncertified boarding care homes unless they provide services for five or more
persons whose primary diagnosis is mental illness or a developmental disability;

(15) programs for children such as scouting, boys clubs, girls clubs, and sports and art
programs, and nonresidential programs for children provided for a cumulative total of less
than 30 days in any 12-month period;

(16) residential programs for persons with mental illness, that are located in hospitals;

(17) the religious instruction of school-age children; Sabbath or Sunday schools; or the
congregate care of children by a church, congregation, or religious society during the period
used by the church, congregation, or religious society for its regular worship;

(18) camps licensed by the commissioner of health under Minnesota Rules, chapter
4630;

(19) mental health outpatient services for adults with mental illness or children with
emotional disturbance;

(20) residential programs serving school-age children whose sole purpose is cultural or
educational exchange, until the commissioner adopts appropriate rules;

(21) community support services programs as defined in section 245.462, subdivision
6, and family community support services as defined in section 245.4871, subdivision 17;

(22) the placement of a child by a birth parent or legal guardian in a preadoptive home
for purposes of adoption as authorized by section 259.47;

(23) settings registered under chapter 144D which provide home care services licensed
by the commissioner of health to fewer than seven adults;

(24) substance use disorder treatment activities of licensed professionals in private
practice as defined in section 245G.01, subdivision 17;

(25) consumer-directed community support service funded under the Medicaid waiver
for persons with developmental disabilities when the individual who provided the service
is:

(i) the same individual who is the direct payee of these specific waiver funds or paid by
a fiscal agent, fiscal intermediary, or employer of record; and

(ii) not otherwise under the control of a residential or nonresidential program that is
required to be licensed under this chapter when providing the service;

(26) a program serving only children who are age 33 months or older, that is operated
by a nonpublic school, for no more than four hours per day per child, with no more than 20
children at any one time, and that is accredited by:

(i) an accrediting agency that is formally recognized by the commissioner of education
as a nonpublic school accrediting organization; or

(ii) an accrediting agency that requires background studies and that receives and
investigates complaints about the services provided.

A program that asserts its exemption from licensure under item (ii) shall, upon request
from the commissioner, provide the commissioner with documentation from the accrediting
agency that verifies: that the accreditation is current; that the accrediting agency investigates
complaints about services; and that the accrediting agency's standards require background
studies on all people providing direct contact services;

(27) a program operated by a nonprofit organization incorporated in Minnesota or another
state that serves youth in kindergarten through grade 12; provides structured, supervised
youth development activities; and has learning opportunities take place before or after
school, on weekends, or during the summer or other seasonal breaks in the school calendar.
A program exempt under this clause is not eligible for child care assistance under chapter
119B. A program exempt under this clause must:

(i) have a director or supervisor on site who is responsible for overseeing written policies
relating to the management and control of the daily activities of the program, ensuring the
health and safety of program participants, and supervising staff and volunteers;

(ii) have obtained written consent from a parent or legal guardian for each youth
participating in activities at the site; and

(iii) have provided written notice to a parent or legal guardian for each youth at the site
that the program is not licensed or supervised by the state of Minnesota and is not eligible
to receive child care assistance payments;

(28) a county that is an eligible vendor under section 254B.05 to provide care coordination
and comprehensive assessment services; or

(29) a recovery community organization that is an eligible vendor under section 254B.05
to provide peer recovery support services.

(b) For purposes of paragraph (a), clause (6), a building is directly contiguous to a
building in which a nonresidential program is located if it shares a common wall with the
building in which the nonresidential program is located or is attached to that building by
skyway, tunnel, atrium, or common roof.

(c) Except for the home and community-based services identified in section 245D.03,
subdivision 1, nothing in this chapter shall be construed to require licensure for any services
provided and funded according to an approved federal waiver plan where licensure is
specifically identified as not being a condition for the services and funding.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2022, or upon federal approval,
whichever is later, if the commissioner of human services determines that federal approval
is necessary to implement this section. The commissioner of human services shall notify
the revisor of statutes if federal approval is not necessary or when federal approval is
obtained.
new text end

Sec. 2.

new text begin [245I.30] CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINICS.
new text end

new text begin Subdivision 1. new text end

new text begin Purpose; licensure. new text end

new text begin (a) The certified community behavioral health clinic
(CCBHC) model is an integrated payment and service delivery model that uses
evidence-based behavioral health practices to achieve better outcomes for individuals with
mental health and substance use disorder diagnoses, while achieving sustainable rates for
providers and economic efficiencies for payors. This section establishes requirements for
CCBHCs.
new text end

new text begin (b) CCBHCs must be licensed in accordance with chapter 245A. Licensed CCBHCs are
not subject to chapter 245C or 260E, section 626.557, or Minnesota Rules, chapter 9544.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the terms defined in this subdivision
have the meanings given them.
new text end

new text begin (b) "Care coordination" means the activities required to coordinate care across settings
and providers for the individuals served by a CCBHC, to ensure seamless transitions across
the full spectrum of health services. Care coordination includes:
new text end

new text begin (1) documenting a plan of care for medical, behavioral health, and social services and
supports in the integrated treatment plan;
new text end

new text begin (2) assisting clients with obtaining appointments and confirming that appointments are
kept;
new text end

new text begin (3) developing a crisis plan;
new text end

new text begin (4) tracking and monitoring client medication needs and compliance; and
new text end

new text begin (5) implementing care coordination agreements with external providers.
new text end

new text begin Care coordination may include psychiatric consultation to primary care practitioners and
mental health clinical care consultation.
new text end

new text begin (c) "Comprehensive evaluation" means a person- and family-centered, trauma-informed
evaluation for the purposes of diagnosis and treatment planning that is completed within
60 days of CCBHC intake by a licensed mental health professional as defined in section
245I.04, subdivision 2. A comprehensive evaluation must meet the requirements for a
standard diagnostic assessment under section 245I.10, subdivision 6.
new text end

new text begin (d) "Culturally and linguistically trained" means an individual has completed training
on how to identify a CCBHC client's cultural and linguistic needs and how to meet those
needs.
new text end

new text begin (e) "Designated collaborating organization" means an entity with a formal agreement
with a CCBHC to furnish CCBHC services. A designated collaborating organization
furnishing services under an agreement with CCBHCs must meet all standards established
in this section for the service the designated collaborating organization is providing. CCBHCs
maintain responsibility for client care coordination and are clinically responsible for services
provided by a designated collaborating organization.
new text end

new text begin (f) "Initial evaluation" means an evaluation completed by a mental health professional
for a client based on behavioral health needs identified in a preliminary screening or risk
assessment. If a client is assessed to have an urgent or crisis behavioral health need, the
initial evaluation must be completed within one business day of CCBHC intake. For all
other new clients, an initial evaluation is required within ten business days of CCBHC
intake. An initial evaluation must include:
new text end

new text begin (1) preliminary diagnoses;
new text end

new text begin (2) the source of the client's referral to the CCBHC;
new text end

new text begin (3) the client's reason for seeking care, as stated by the client or other individuals with
significant involvement in a client's care;
new text end

new text begin (4) identification of the client's immediate clinical care needs related to the client's
behavioral health diagnosis;
new text end

new text begin (5) a list of current prescription and over-the-counter medications and any other substance
the client may be taking;
new text end

new text begin (6) an assessment of whether the client is a risk to self or others, including suicide risk
factors;
new text end

new text begin (7) an assessment of any other client safety concerns;
new text end

new text begin (8) an assessment of need for medical care, with appropriate referrals and follow-up;
and
new text end

new text begin (9) a determination of whether the client is or ever has been a member of the United
States armed services.
new text end

new text begin (g) "Integrated treatment plan" means a plan of care that, based on the client's goals,
guides treatment and interventions and documents the coordination of medical, psychosocial,
emotional, therapeutic, and support needs of the client in a manner consistent with the
client's cultural and linguistic needs. The integrated treatment plan must be developed using
a person- and family-centered planning process that includes the client, any family or
client-identified natural supports, CCBHC service providers, and care coordination staff.
new text end

new text begin (h) "Withdrawal management" means a time-limited service delivered in an office setting,
an outpatient behavioral health clinic, or a person's home by staff providing medically
supervised evaluation and detoxification services to achieve safe and comfortable withdrawal
from substances and facilitate the transition into ongoing treatment and recovery. Withdrawal
management includes assessment, planning, medication prescribing and management, trained
observation of withdrawal symptoms, and supportive services to encourage a CCBHC
client's recovery.
new text end

new text begin Subd. 3. new text end

new text begin CCBHC structure and organization. new text end

new text begin (a) A CCBHC must directly provide
the majority of services listed in subdivision 6, paragraph (a), except that a CCBHC may
contract with an entity that is a designated collaborating organization with the required
authority to provide specified services. A designated collaborating organization must:
new text end

new text begin (1) have a formal agreement with the CCBHC to furnish one or more of the services
listed in subdivision 6, paragraph (a);
new text end

new text begin (2) provide assurances that it will provide services according to CCBHC service standards
and provider requirements;
new text end

new text begin (3) agree that the CCBHC is responsible for coordinating care and has clinical and
financial responsibility for the services that the entity provides under the agreement; and
new text end

new text begin (4) meet any additional requirements issued by the commissioner.
new text end

new text begin (b) A clinic that meets the requirements for CCBHC licensure under this section and
chapter 245A is not subject to any other state law or rule that requires a county contract or
other form of county approval as a condition for licensure or enrollment as a provider under
medical assistance.
new text end

new text begin Subd. 4. new text end

new text begin Minimum staffing requirements. new text end

new text begin A CCBHC must employ or contract for
clinic staff who have backgrounds in diverse disciplines, including licensed mental health
professionals and licensed alcohol and drug counselors; are culturally and linguistically
trained to meet the needs of the population the clinic serves; and are trained to provide
accommodations to meet the needs of clients with disabilities. CCBHC staff providing
behavioral health services or supports must comply with relevant licensing requirements
and other requirements issued by the commissioner in accordance with the Medicaid state
plan.
new text end

new text begin Subd. 5. new text end

new text begin Service accessibility and availability. new text end

new text begin A CCBHC must ensure that clinic
services are available and accessible to families and individuals of all ages and genders and
that crisis management services are available 24 hours per day, seven days per week. A
CCBHC must establish fees for clinic services for individuals who are not enrolled in medical
assistance using a sliding fee scale that ensures services to clients are not denied or limited
due to a client's inability to pay for services.
new text end

new text begin Subd. 6. new text end

new text begin Required services. new text end

new text begin (a) A CCBHC must provide the following services:
new text end

new text begin (1) crisis mental health and substance use disorder services, withdrawal management
services, emergency crisis intervention services, and stabilization services through existing
mobile crisis services;
new text end

new text begin (2) screening, assessment, and diagnosis services, including risk assessments and level
of care determinations;
new text end

new text begin (3) person- and family-centered treatment planning;
new text end

new text begin (4) outpatient mental health and substance use disorder services;
new text end

new text begin (5) targeted case management;
new text end

new text begin (6) psychiatric rehabilitation services;
new text end

new text begin (7) peer support and counselor services and family support services; and
new text end

new text begin (8) intensive community-based mental health services, including mental health services
for members of the armed forces and veterans.
new text end

new text begin (b) A CCBHC must directly provide the majority of these services to its clients, but it
may coordinate the delivery of some of the services required under paragraph (a) with a
designated collaborating organization.
new text end

new text begin (c) A CCBHC must provide coordination of care across settings and providers to ensure
seamless transitions for individuals being served across the full spectrum of health services,
including acute, chronic, and behavioral needs.
new text end

new text begin (d) To be licensed as a CCBHC, a provider entity must meet the requirements for
screening and risk assessments, initial evaluations, comprehensive evaluations, and integrated
treatment plans as defined in this chapter and must meet the standards for the following
behavioral health services:
new text end

new text begin (1) mental health clinics under section 245I.20;
new text end

new text begin (2) substance use disorder treatment under chapter 245G;
new text end

new text begin (3) children's therapeutic services and supports under section 245I.40;
new text end

new text begin (4) adult rehabilitative mental health services under section 256B.0623;
new text end

new text begin (5) mental health crisis response services under sections 256B.0624 and 256B.0944;
new text end

new text begin (6) mental health targeted case management under section 256B.0625, subdivision 20;
and
new text end

new text begin (7) peer services under sections 256B.0615, 256B.0616, and 245G.07, subdivision 1,
paragraph (a), clause (5), as applicable when peer services are provided.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2022, or upon federal approval,
whichever is later, if the commissioner of human services determines that federal approval
is necessary to implement this section. The commissioner of human services shall notify
the revisor of statutes if federal approval is not necessary or when federal approval is
obtained.
new text end

Sec. 3.

new text begin [245I.40] CHILDREN'S THERAPEUTIC SERVICES AND SUPPORTS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have
the meanings given them.
new text end

new text begin (b) "Care consultation" means consultative activities and communications between
mental health care providers and primary care clinical care providers, families, school
support staff, and clients. Care consultation may include psychiatric consultation with
primary care practitioners and mental health clinical care consultation.
new text end

new text begin (c) "Care coordination" means the activities required to coordinate care across settings
and providers for the people served to ensure seamless transitions across the full spectrum
of health services. Care coordination includes documenting a plan of care for medical care,
behavioral health, and social services and supports in the integrated treatment plan, assisting
with obtaining appointments, confirming that clients attend appointments, developing a
crisis plan, tracking medication, and implementing care coordination agreements with
external providers. Care coordination may include psychiatric consultation with primary
care practitioners and mental health clinical care consultation.
new text end

new text begin (d) "Children's therapeutic services and supports" means the flexible package of mental
health services for children who require varying therapeutic and rehabilitative levels of
intervention to treat a diagnosed emotional disturbance, as defined in section 245.4871,
subdivision 15, or a diagnosed mental illness, as defined in section 245.462, subdivision
20. The services are time-limited interventions that are delivered using various treatment
modalities and combinations of services designed to reach treatment outcomes identified
in the individual treatment plan.
new text end

new text begin (e) "Clinical trainee" means a staff person who is qualified according to section 245I.04,
subdivision 6.
new text end

new text begin (f) "Crisis planning" has the meaning given in section 245.4871, subdivision 9a.
new text end

new text begin (g) "Culturally competent provider" means a provider who understands and can utilize
to a client's benefit the client's culture when providing services to the client. A provider
may be culturally competent because the provider is of the same cultural or ethnic group
as the client or the provider has developed the knowledge and skills through training and
experience to provide services to culturally diverse clients.
new text end

new text begin (h) "Day treatment program" for children means a site-based structured mental health
program consisting of psychotherapy for three or more individuals and individual or group
skills training provided by a team, under the treatment supervision of a mental health
professional.
new text end

new text begin (i) "Standard diagnostic assessment" means the assessment described in section 245I.10,
subdivision 6.
new text end

new text begin (j) "Direct service time" means the time that a mental health professional, clinical trainee,
mental health practitioner, or mental health behavioral aide spends face-to-face with a client
and the client's family or providing covered services through telehealth as defined under
section 256B.0625, subdivision 3b. Direct service time includes time in which the provider
obtains a client's history, develops a client's treatment plan, records individual treatment
outcomes, or provides service components of children's therapeutic services and supports.
Direct service time does not include time doing work before and after providing direct
services, including scheduling or maintaining clinical records.
new text end

new text begin (k) "Emotional disturbance" has the meaning given in section 245.4871, subdivision 15.
new text end

new text begin (l) "Individual treatment plan" means the plan described in section 245I.10, subdivisions
7 and 8.
new text end

new text begin (m) "Mental health behavioral aide services" means medically necessary one-on-one
activities performed by a mental health behavioral aide qualified according to section
245I.04, subdivision 16, to assist a child retain or generalize psychosocial skills as previously
trained by a mental health professional, clinical trainee, or mental health practitioner and
as described in the child's individual treatment plan and individual behavior plan. Activities
involve working directly with the child or child's family as provided in subdivision 8,
paragraph (b), clause (4).
new text end

new text begin (n) "Mental health certified family peer specialist" means a staff person who is qualified
according to section 245I.04, subdivision 12.
new text end

new text begin (o) "Mental health practitioner" means a staff person who is qualified according to section
245I.04, subdivision 4.
new text end

new text begin (p) "Mental health professional" means a staff person who is qualified according to
section 245I.04, subdivision 2.
new text end

new text begin (q) "Mental illness," for persons at least age 18 but under age 21, has the meaning given
in section 245.462, subdivision 20, paragraph (a).
new text end

new text begin (r) "Psychotherapy" means the treatment described in section 256B.0671, subdivision
11.
new text end

new text begin (s) "Rehabilitative services" or "psychiatric rehabilitation services" means interventions
to: (1) restore a child or adolescent to an age-appropriate developmental trajectory that had
been disrupted by a psychiatric illness; or (2) enable the child to self-monitor, compensate
for, cope with, counteract, or replace psychosocial skills deficits or maladaptive skills
acquired over the course of a psychiatric illness. Psychiatric rehabilitation services for
children combine coordinated psychotherapy to address internal psychological, emotional,
and intellectual processing deficits, and skills training to restore personal and social
functioning. Psychiatric rehabilitation services establish a progressive series of goals with
each achievement building upon a prior achievement.
new text end

new text begin (t) "Skills training" means individual, family, or group training, delivered by or under
the supervision of a mental health professional, designed to facilitate the acquisition of
psychosocial skills that are medically necessary to rehabilitate the child to an age-appropriate
developmental trajectory heretofore disrupted by a psychiatric illness or to enable the child
to self-monitor, compensate for, cope with, counteract, or replace skills deficits or
maladaptive skills acquired over the course of a psychiatric illness. Skills training is subject
to the service delivery requirements under subdivision 8, paragraph (b), clause (2).
new text end

new text begin (u) "Treatment supervision" means the supervision described in section 245I.06.
new text end

new text begin Subd. 2. new text end

new text begin Covered service components of children's therapeutic services and
supports. new text end

new text begin (a) Subject to federal approval, medical assistance covers medically necessary
children's therapeutic services and supports when the services are provided by an eligible
provider entity certified under and meeting the standards in this section. The provider entity
must make reasonable and good faith efforts to report individual client outcomes to the
commissioner, using instruments and protocols approved by the commissioner.
new text end

new text begin (b) The service components of children's therapeutic services and supports are:
new text end

new text begin (1) patient and/or family psychotherapy, family psychotherapy, psychotherapy for crisis,
and group psychotherapy;
new text end

new text begin (2) individual, family, or group skills training provided by a mental health professional,
clinical trainee, or mental health practitioner;
new text end

new text begin (3) crisis planning;
new text end

new text begin (4) mental health behavioral aide services;
new text end

new text begin (5) direction of a mental health behavioral aide;
new text end

new text begin (6) mental health service plan development;
new text end

new text begin (7) children's day treatment;
new text end

new text begin (8) care coordination;
new text end

new text begin (9) care consultation;
new text end

new text begin (10) travel to and from a client's location; and
new text end

new text begin (11) individual treatment plan development.
new text end

new text begin Subd. 3. new text end

new text begin Determination of client eligibility. new text end

new text begin (a) A client's eligibility to receive children's
therapeutic services and supports under this section shall be determined based on a standard
diagnostic assessment by a mental health professional or a clinical trainee that is performed
within one year before the initial start of service. The standard diagnostic assessment must:
new text end

new text begin (1) determine whether a child under age 18 has a diagnosis of emotional disturbance or,
if the person is between the ages of 18 and 21, whether the person has a mental illness;
new text end

new text begin (2) document children's therapeutic services and supports as medically necessary to
address an identified disability, functional impairment, and the individual client's needs and
goals; and
new text end

new text begin (3) be used in the development of the individual treatment plan.
new text end

new text begin (b) Notwithstanding paragraph (a), a client may be determined to be eligible for day
treatment under this section based on a hospital's medical history and presentation
examination of the client.
new text end

new text begin Subd. 4. new text end

new text begin Provider entity certification. new text end

new text begin (a) The commissioner shall establish an initial
provider entity application and certification process and recertification process to determine
whether a provider entity has an administrative and clinical infrastructure that meets the
requirements in subdivisions 5 and 6. The commissioner shall recertify a provider entity
every three years. The commissioner shall establish a process for decertification of a provider
entity and shall require corrective action, medical assistance repayment, or decertification
of a provider entity that no longer meets the requirements in this section or that fails to meet
the clinical quality standards or administrative standards provided by the commissioner in
the application and certification process.
new text end

new text begin (b) For purposes of this section, a provider entity must meet the standards in this section
and this chapter, as required under section 245I.011, subdivision 5, and be:
new text end

new text begin (1) an Indian health services facility or a facility owned and operated by a Tribe or Tribal
organization operating as a 638 facility under Public Law 93-638 certified by the state;
new text end

new text begin (2) a county-operated entity certified by the state; or
new text end

new text begin (3) a noncounty entity certified by the state.
new text end

new text begin Subd. 5. new text end

new text begin Provider entity clinical infrastructure requirements. new text end

new text begin (a) To be an eligible
provider entity under this section, a provider entity must have a clinical infrastructure that
utilizes diagnostic assessment, individual treatment plans, service delivery, and individual
treatment plan review that are culturally competent, child-centered, and family-driven to
achieve maximum benefit for the client. The provider entity must review, and update as
necessary, the clinical policies and procedures every three years, must distribute the policies
and procedures to staff initially and upon each subsequent update, and must train staff
accordingly.
new text end

new text begin (b) The clinical infrastructure written policies and procedures must include policies and
procedures for meeting the requirements in this subdivision:
new text end

new text begin (1) providing or obtaining a client's standard diagnostic assessment, including a standard
diagnostic assessment. When required components of the standard diagnostic assessment
are not provided in an outside or independent assessment or cannot be attained immediately,
the provider entity must determine the missing information within 30 days and amend the
child's standard diagnostic assessment or incorporate the information into the child's
individual treatment plan;
new text end

new text begin (2) developing an individual treatment plan;
new text end

new text begin (3) providing treatment supervision plans for staff according to section 245I.06. Treatment
supervision does not include the authority to make or terminate court-ordered placements
of the child. A treatment supervisor must be available for urgent consultation as required
by the individual client's needs or the situation;
new text end

new text begin (4) ensuring the immediate accessibility of a mental health professional, clinical trainee,
or mental health practitioner to the behavioral aide during service delivery;
new text end

new text begin (5) providing service delivery that implements the individual treatment plan and meets
the requirements under subdivision 8; and
new text end

new text begin (6) individual treatment plan review. The review must determine the extent to which
the services have met each of the goals and objectives in the treatment plan. The review
must assess the client's progress and ensure that services and treatment goals continue to
be necessary and appropriate to the client and the client's family or foster family.
new text end

new text begin Subd. 5a. new text end

new text begin Background studies. new text end

new text begin The requirements for background studies under section
245I.011, subdivision 4, paragraph (d), may be met by a children's therapeutic services and
supports services agency through the commissioner's NETStudy system as provided under
sections 245C.03, subdivision 7, and 245C.10, subdivision 8.
new text end

new text begin Subd. 6. new text end

new text begin Provider entity administrative infrastructure requirements. new text end

new text begin (a) An eligible
provider entity shall demonstrate the availability, by means of employment or contract, of
at least one backup mental health professional in the event of the primary mental health
professional's absence.
new text end

new text begin (b) In addition to the policies and procedures required under section 245I.03, the policies
and procedures must include:
new text end

new text begin (1) fiscal procedures, including internal fiscal control practices and a process for collecting
revenue that is compliant with federal and state laws; and
new text end

new text begin (2) a client-specific treatment outcomes measurement system, including baseline
measures, to measure a client's progress toward achieving mental health rehabilitation goals.
new text end

new text begin (c) A provider entity that uses a restrictive procedure with a client must meet the
requirements of section 245.8261.
new text end

new text begin Subd. 7. new text end

new text begin Provider entity clinical infrastructure requirements. new text end

new text begin (a) To be an eligible
provider entity under this section, a provider entity must have a clinical infrastructure that
utilizes diagnostic assessment, individual treatment plans, service delivery, and individual
treatment plan review that are culturally competent, child-centered, and family-driven to
achieve maximum benefit for the client. The provider entity must review, and update as
necessary, the clinical policies and procedures every three years, must distribute the policies
and procedures to staff initially and upon each subsequent update, and must train staff
accordingly.
new text end

new text begin (b) The clinical infrastructure written policies and procedures must include policies and
procedures for meeting the requirements in this subdivision:
new text end

new text begin (1) providing or obtaining a client's standard diagnostic assessment, including a standard
diagnostic assessment. When required components of the standard diagnostic assessment
are not provided in an outside or independent assessment or cannot be attained immediately,
the provider entity must determine the missing information within 30 days and amend the
child's standard diagnostic assessment or incorporate the information into the child's
individual treatment plan;
new text end

new text begin (2) developing an individual treatment plan;
new text end

new text begin (3) developing an individual behavior plan that documents and describes interventions
to be provided by the mental health behavioral aide. The individual behavior plan must
include:
new text end

new text begin (i) detailed instructions on the psychosocial skills to be practiced;
new text end

new text begin (ii) time allocated to each intervention;
new text end

new text begin (iii) methods of documenting the child's behavior;
new text end

new text begin (iv) methods of monitoring the child's progress in reaching objectives; and
new text end

new text begin (v) goals to increase or decrease targeted behavior as identified in the individual treatment
plan;
new text end

new text begin (4) providing treatment supervision plans for staff according to section 245I.06. Treatment
supervision does not include the authority to make or terminate court-ordered placements
of the child. A treatment supervisor must be available for urgent consultation as required
by the individual client's needs or the situation;
new text end

new text begin (5) meeting day treatment program conditions in items (i) and (ii):
new text end

new text begin (i) the treatment supervisor must be present and available on the premises more than 50
percent of the time in a provider's standard working week during which the supervisee is
providing a mental health service; and
new text end

new text begin (ii) every 30 days, the treatment supervisor must review and sign the record indicating
the supervisor has reviewed the client's care for all activities in the preceding 30-day period;
new text end

new text begin (6) meeting the treatment supervision standards in items (i) and (ii) for all other services
provided under CTSS:
new text end

new text begin (i) the mental health professional is required to be present at the site of service delivery
for observation as clinically appropriate when the clinical trainee, mental health practitioner,
or mental health behavioral aide is providing CTSS services; and
new text end

new text begin (ii) when conducted, the on-site presence of the mental health professional must be
documented in the child's record and signed by the mental health professional who accepts
full professional responsibility;
new text end

new text begin (7) providing direction to a mental health behavioral aide. For entities that employ mental
health behavioral aides, the treatment supervisor must be employed by the provider entity
or other provider certified to provide mental health behavioral aide services to ensure
necessary and appropriate oversight for the client's treatment and continuity of care. The
staff giving direction must begin with the goals on the individual treatment plan, and instruct
the mental health behavioral aide on how to implement therapeutic activities and interventions
that will lead to goal attainment. The staff giving direction must also instruct the mental
health behavioral aide about the client's diagnosis, functional status, and other characteristics
that are likely to affect service delivery. Direction must also include determining that the
mental health behavioral aide has the skills to interact with the client and the client's family
in ways that convey personal and cultural respect and that the aide actively solicits
information relevant to treatment from the family. The aide must be able to clearly explain
or demonstrate the activities the aide is doing with the client and the activities' relationship
to treatment goals. Direction is more didactic than is supervision and requires the staff
providing it to continuously evaluate the mental health behavioral aide's ability to carry out
the activities of the individual treatment plan and the individual behavior plan. When
providing direction, the staff must:
new text end

new text begin (i) review progress notes prepared by the mental health behavioral aide for accuracy and
consistency with diagnostic assessment, treatment plan, and behavior goals and the staff
must approve and sign the progress notes;
new text end

new text begin (ii) identify changes in treatment strategies, revise the individual behavior plan, and
communicate treatment instructions and methodologies as appropriate to ensure that treatment
is implemented correctly;
new text end

new text begin (iii) demonstrate family-friendly behaviors that support healthy collaboration among
the child, the child's family, and providers as treatment is planned and implemented;
new text end

new text begin (iv) ensure that the mental health behavioral aide is able to effectively communicate
with the child, the child's family, and the provider;
new text end

new text begin (v) record the results of any evaluation and corrective actions taken to modify the work
of the mental health behavioral aide; and
new text end

new text begin (vi) ensure the immediate accessibility of a mental health professional, clinical trainee,
or mental health practitioner to the behavioral aide during service delivery;
new text end

new text begin (8) providing service delivery that implements the individual treatment plan and meets
the requirements under subdivision 9; and
new text end

new text begin (9) individual treatment plan review. The review must determine the extent to which
the services have met each of the goals and objectives in the treatment plan. The review
must assess the client's progress and ensure that services and treatment goals continue to
be necessary and appropriate to the client and the client's family or foster family.
new text end

new text begin Subd. 8. new text end

new text begin Qualifications of individual and team providers. new text end

new text begin (a) An individual or team
provider working within the scope of the provider's practice or qualifications may provide
service components of children's therapeutic services and supports that are identified as
medically necessary in a client's individual treatment plan.
new text end

new text begin (b) An individual provider must be qualified as a:
new text end

new text begin (1) mental health professional;
new text end

new text begin (2) clinical trainee;
new text end

new text begin (3) mental health practitioner;
new text end

new text begin (4) mental health certified family peer specialist; or
new text end

new text begin (5) mental health behavioral aide.
new text end

new text begin (c) A day treatment team must include one mental health professional or clinical trainee.
new text end

new text begin Subd. 9. new text end

new text begin Required preservice and continuing education. new text end

new text begin A provider entity shall
establish a plan to provide preservice and continuing education for staff. The plan must
clearly describe the type of training necessary to maintain current skills and obtain new
skills and that relates to the provider entity's goals and objectives for services offered.
new text end

new text begin Subd. 10. new text end

new text begin Service delivery criteria. new text end

new text begin (a) In delivering services under this section, a
certified provider entity must ensure that:
new text end

new text begin (1) the provider's caseload size should reasonably enable the provider to play an active
role in service planning, monitoring, and delivering services to meet the client's and client's
family's needs, as specified in each client's individual treatment plan;
new text end

new text begin (2) site-based programs, including day treatment programs, provide staffing and facilities
to ensure the client's health, safety, and protection of rights, and that the programs are able
to implement each client's individual treatment plan; and
new text end

new text begin (3) a day treatment program is provided to a group of clients by a team under the treatment
supervision of a mental health professional. The day treatment program must be provided
in and by: (i) an outpatient hospital accredited by the Joint Commission on Accreditation
of Health Organizations and licensed under sections 144.50 to 144.55; (ii) a community
mental health center under section 245.62; or (iii) an entity that is certified under subdivision
4 to operate a program that meets the requirements of section 245.4884, subdivision 2, and
Minnesota Rules, parts 9505.0170 to 9505.0475. The day treatment program must stabilize
the client's mental health status while developing and improving the client's independent
living and socialization skills. The goal of the day treatment program must be to reduce or
relieve the effects of mental illness and provide training to enable the client to live in the
community. The remainder of the structured treatment program may include patient and/or
family or group psychotherapy, and individual or group skills training, if included in the
client's individual treatment plan. Day treatment programs are not part of inpatient or
residential treatment services. When a day treatment group that meets the minimum group
size requirement temporarily falls below the minimum group size because of a member's
temporary absence, medical assistance covers a group session conducted for the group
members in attendance. A day treatment program may provide fewer than the minimally
required hours for a particular child during a billing period in which the child is transitioning
into, or out of, the program.
new text end

new text begin (b) To be eligible for medical assistance payment, a provider entity must deliver the
service components of children's therapeutic services and supports in compliance with the
following requirements:
new text end

new text begin (1) psychotherapy to address the child's underlying mental health disorder must be
documented as part of the child's ongoing treatment. A provider must deliver, or arrange
for, medically necessary psychotherapy, unless the child's parent or caregiver chooses not
to receive it. When a provider determines that a child needs psychotherapy but psychotherapy
cannot be delivered due to a shortage of licensed mental health professionals in the child's
community, the provider must document the lack of access in the child's medical record;
new text end

new text begin (2) individual, family, or group skills training is subject to the following requirements:
new text end

new text begin (i) a mental health professional, clinical trainee, or mental health practitioner shall provide
skills training;
new text end

new text begin (ii) skills training delivered to a child or the child's family must be targeted to the specific
deficits or maladaptations of the child's mental health disorder and must be prescribed in
the child's individual treatment plan;
new text end

new text begin (iii) group skills training may be provided to multiple recipients who, because of the
nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from
interaction in a group setting, which must be staffed as follows:
new text end

new text begin (A) one mental health professional, clinical trainee, or mental health practitioner must
work with a group of three to eight clients; or
new text end

new text begin (B) any combination of two mental health professionals, clinical trainees, or mental
health practitioners must work with a group of nine to 12 clients;
new text end

new text begin (iv) a mental health professional, clinical trainee, or mental health practitioner must have
taught the psychosocial skill before a mental health behavioral aide may practice that skill
with the client; and
new text end

new text begin (v) for group skills training, when a skills group that meets the minimum group size
requirement temporarily falls below the minimum group size because of a group member's
temporary absence, the provider may conduct the session for the group members in
attendance;
new text end

new text begin (3) crisis planning to a child and family must include development of a written plan that
anticipates the particular factors specific to the child that may precipitate a psychiatric crisis
for the child in the near future. The written plan must document actions that the family
should be prepared to take to resolve or stabilize a crisis, such as advance arrangements for
direct intervention and support services to the child and the child's family. Crisis planning
must include preparing resources designed to address abrupt or substantial changes in the
functioning of the child or the child's family when sudden change in behavior or a loss of
usual coping mechanisms is observed, or the child begins to present a danger to self or
others;
new text end

new text begin (4) mental health behavioral aide services must be medically necessary treatment services,
identified in the child's individual treatment plan and individual behavior plan. To be eligible
for medical assistance payment, mental health behavioral aide services must be delivered
to a child who has been diagnosed with an emotional disturbance or a mental illness, as
provided in subdivision 1, paragraph (m). The mental health behavioral aide must document
the delivery of services in written progress notes. Progress notes must reflect implementation
of the treatment strategies, as performed by the mental health behavioral aide and the child's
responses to the treatment strategies; and
new text end

new text begin (5) mental health service plan development must be performed in consultation with the
child's family and, when appropriate, with other key participants in the child's life by the
child's treating mental health professional or clinical trainee or by a mental health practitioner
and approved by the treating mental health professional. Treatment plan drafting consists
of development, review, and revision by face-to-face or electronic communication. The
provider must document events, including the time spent with the family and other key
participants in the child's life to approve the individual treatment plan. Medical assistance
covers service plan development before completion of the child's individual treatment plan.
Service plan development is covered only if a treatment plan is completed for the child. If
upon review it is determined that a treatment plan was not completed for the child, the
commissioner shall recover the payment for the service plan development.
new text end

new text begin Subd. 11. new text end

new text begin Documentation and billing. new text end

new text begin A provider entity must document the services
it provides under this section. The provider entity must ensure that documentation complies
with Minnesota Rules, parts 9505.2175 and 9505.2197. Services billed under this section
that are not documented according to this subdivision shall be subject to monetary recovery
by the commissioner. Billing for covered service components under subdivision 2, paragraph
(b), must not include anything other than direct service time.
new text end

new text begin Subd. 12. new text end

new text begin Excluded services. new text end

new text begin The following services are not eligible for medical
assistance payment as children's therapeutic services and supports:
new text end

new text begin (1) service components of children's therapeutic services and supports simultaneously
provided by more than one provider entity unless prior authorization is obtained;
new text end

new text begin (2) treatment by multiple providers within the same agency at the same clock time;
new text end

new text begin (3) children's therapeutic services and supports provided in violation of medical assistance
policy in Minnesota Rules, part 9505.0220;
new text end

new text begin (4) mental health behavioral aide services provided by a personal care assistant who is
not qualified as a mental health behavioral aide and employed by a certified children's
therapeutic services and supports provider entity;
new text end

new text begin (5) service components of CTSS that are the responsibility of a residential or program
license holder, including foster care providers under the terms of a service agreement or
administrative rules governing licensure; and
new text end

new text begin (6) adjunctive activities that may be offered by a provider entity but are not otherwise
covered by medical assistance, including:
new text end

new text begin (i) a service that is primarily recreation oriented or that is provided in a setting that is
not medically supervised. This includes sports activities, exercise groups, activities such as
craft hours, leisure time, social hours, meal or snack time, trips to community activities,
and tours;
new text end

new text begin (ii) a social or educational service that does not have or cannot reasonably be expected
to have a therapeutic outcome related to the client's emotional disturbance;
new text end

new text begin (iii) prevention or education programs provided to the community; and
new text end

new text begin (iv) treatment for clients with primary diagnoses of alcohol or other drug abuse.
new text end

new text begin Subd. 13. new text end

new text begin Exception to excluded services. new text end

new text begin Notwithstanding subdivision 12, up to 15
hours of children's therapeutic services and supports provided within a six-month period to
a child with severe emotional disturbance who is residing in a hospital; a residential treatment
facility licensed under Minnesota Rules, parts 2960.0580 to 2960.0690; a psychiatric
residential treatment facility under section 256B.0625, subdivision 45a; a regional treatment
center; or other institutional group setting or who is participating in a program of partial
hospitalization are eligible for medical assistance payment if part of the discharge plan.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 4.

Minnesota Statutes 2021 Supplement, section 256B.0625, subdivision 5m, is
amended to read:

Subd. 5m.

Certified community behavioral health clinic services.

(a) Medical
assistance covers new text begin services provided by a not-for-profit new text end certified community behavioral health
clinic (CCBHC) deleted text begin services deleted text end that deleted text begin meet the requirements of section 245.735, subdivision 3 deleted text end new text begin is
licensed by the commissioner under section 245I.30 and chapter 245A new text end .

(b) The commissioner shall reimburse CCBHCs on a deleted text begin per-visit deleted text end new text begin per-day new text end basis deleted text begin under the
prospective payment deleted text end new text begin for each day that an eligible service is delivered, using the CCBHC
daily bundled rate new text end system for medical assistance payments as described in paragraph (c).
The commissioner shall include a quality incentive payment in the deleted text begin prospective payment deleted text end
new text begin CCBHC daily bundled rate new text end system as described in paragraph (e). There is no county share
for medical assistance services when reimbursed through the CCBHC deleted text begin prospective payment deleted text end new text begin
daily bundled rate new text end system.

(c) The commissioner shall ensure that the deleted text begin prospective payment deleted text end new text begin CCBHC daily bundled
rate new text end system for CCBHC payments under medical assistance meets the following requirements:

(1) the deleted text begin prospective payment deleted text end new text begin CCBHC daily bundled new text end rate shall be a provider-specific rate
calculated for each CCBHC, based on the daily cost of providing CCBHC services and the
total annual allowable new text begin CCBHC new text end costs deleted text begin for CCBHCs deleted text end divided by the total annual number of
CCBHC visits. For calculating the payment rate, total annual visits include visits covered
by medical assistance and visits not covered by medical assistance. Allowable costs include
but are not limited to the salaries and benefits of medical assistance providers; the cost of
CCBHC services provided under section deleted text begin 245.735, subdivision 3, paragraph (a), clauses (6)
and (7) deleted text end new text begin 245I.30, subdivision 6, paragraph (a) new text end ; and other costs such as insurance or supplies
needed to provide CCBHC services;

(2) payment shall be limited to one payment per day per medical assistance enrollee deleted text begin for
each deleted text end new text begin when an eligible new text end CCBHC deleted text begin visit eligible for reimbursement deleted text end new text begin service is provided new text end . A
CCBHC visit is eligible for reimbursement if at least one of the CCBHC services listed
under section deleted text begin 245.735, subdivision 3, paragraph (a), clause (6) deleted text end new text begin 245I.30, subdivision 6,
paragraph (a) new text end , is furnished to a medical assistance enrollee by a health care practitioner or
licensed agency employed by or under contract with a CCBHC;

(3) deleted text begin new payment deleted text end new text begin initial CCBHC daily bundled new text end rates deleted text begin set by the commissioner deleted text end for newly
deleted text begin certified deleted text end new text begin licensed new text end CCBHCs under section deleted text begin 245.735, subdivision 3, deleted text end new text begin 245I.30 new text end shall be deleted text begin based
on rates for established CCBHCs with a similar scope of services. If no comparable CCBHC
exists, the commissioner shall establish a clinic-specific rate using audited historical cost
report data adjusted for the estimated cost of delivering CCBHC services, including the
estimated cost of providing the full scope of services and the projected change in visits
resulting from the change in scope deleted text end new text begin established by the commissioner using a provider-specific
rate based on the newly certified CCBHC's audited historical cost report data adjusted for
the expected cost of delivering CCBHC services. Estimates are subject to review by the
commissioner and must include the expected cost of providing the full scope of CCBHC
services and the expected number of visits for the rate period new text end ;

(4) the commissioner shall rebase CCBHC rates once every three years new text begin following the
last rebasing new text end and no less than 12 months following an initial rate or a rate change due to a
change in the scope of services;

(5) the commissioner shall provide for a 60-day appeals process after notice of the results
of the rebasing;

(6) the deleted text begin prospective payment deleted text end new text begin CCBHC daily bundled new text end rate under this section does not apply
to services rendered by CCBHCs to individuals who are dually eligible for Medicare and
medical assistance when Medicare is the primary payer for the service. An entity that receives
a deleted text begin prospective payment deleted text end new text begin CCBHC daily bundled rate new text end system deleted text begin rate deleted text end that overlaps with the CCBHC
rate is not eligible for the CCBHC rate;

(7) payments for CCBHC services to individuals enrolled in managed care shall be
coordinated with the state's phase-out of CCBHC wrap payments. The commissioner shall
complete the phase-out of CCBHC wrap payments within 60 days of the implementation
of the deleted text begin prospective payment deleted text end new text begin CCBHC daily bundled rate new text end system in the Medicaid Management
Information System (MMIS), for CCBHCs reimbursed under this chapter, with a final
settlement of payments due made payable to CCBHCs no later than 18 months thereafter;

(8) the deleted text begin prospective payment deleted text end new text begin CCBHC daily bundled new text end rate for each CCBHC shall be updated
by trending each provider-specific rate by the Medicare Economic Index for primary care
services. This update shall occur each year in between rebasing periods determined by the
commissioner in accordance with clause (4). CCBHCs must provide data on costs and visits
to the state annually using the CCBHC cost report established by the commissioner; and

(9) a CCBHC may request a rate adjustment for changes in the CCBHC's scope of
services when such changes are expected to result in an adjustment to the CCBHC payment
rate by 2.5 percent or more. The CCBHC must provide the commissioner with information
regarding the changes in the scope of services, including the estimated cost of providing
the new or modified services and any projected increase or decrease in the number of visits
resulting from the change. new text begin Estimated costs are subject to review by the commissioner. new text end Rate
adjustments for changes in scope shall occur no more than once per year in between rebasing
periods per CCBHC and are effective on the date of the annual CCBHC rate update.

(d) Managed care plans and county-based purchasing plans shall reimburse CCBHC
providers at the deleted text begin prospective payment deleted text end new text begin CCBHC daily bundled new text end rate. The commissioner shall
monitor the effect of this requirement on the rate of access to the services delivered by
CCBHC providers. If, for any contract year, federal approval is not received for this
paragraph, the commissioner must adjust the capitation rates paid to managed care plans
and county-based purchasing plans for that contract year to reflect the removal of this
provision. Contracts between managed care plans and county-based purchasing plans and
providers to whom this paragraph applies must allow recovery of payments from those
providers if capitation rates are adjusted in accordance with this paragraph. Payment
recoveries must not exceed the amount equal to any increase in rates that results from this
provision. This paragraph expires if federal approval is not received for this paragraph at
any time.

(e) The commissioner shall implement a quality incentive payment program for CCBHCs
that meets the following requirements:

(1) a CCBHC shall receive a quality incentive payment upon meeting specific numeric
thresholds for performance metrics established by the commissioner, in addition to payments
for which the CCBHC is eligible under the deleted text begin prospective payment deleted text end new text begin CCBHC daily bundled
rate new text end system described in paragraph (c);

(2) a CCBHC must be certified and enrolled as a CCBHC for the entire measurement
year to be eligible for incentive payments;

(3) each CCBHC shall receive written notice of the criteria that must be met in order to
receive quality incentive payments at least 90 days prior to the measurement year; and

(4) a CCBHC must provide the commissioner with data needed to determine incentive
payment eligibility within six months following the measurement year. The commissioner
shall notify CCBHC providers of their performance on the required measures and the
incentive payment amount within 12 months following the measurement year.

(f) All claims to managed care plans for CCBHC services as provided under this section
shall be submitted directly to, and paid by, the commissioner on the dates specified no later
than January 1 of the following calendar year, if:

(1) one or more managed care plans does not comply with the federal requirement for
payment of clean claims to CCBHCs, as defined in Code of Federal Regulations, title 42,
section 447.45(b), and the managed care plan does not resolve the payment issue within 30
days of noncompliance; and

(2) the total amount of clean claims not paid in accordance with federal requirements
by one or more managed care plans is 50 percent of, or greater than, the total CCBHC claims
eligible for payment by managed care plans.

If the conditions in this paragraph are met between January 1 and June 30 of a calendar
year, claims shall be submitted to and paid by the commissioner beginning on January 1 of
the following year. If the conditions in this paragraph are met between July 1 and December
31 of a calendar year, claims shall be submitted to and paid by the commissioner beginning
on July 1 of the following year.

Sec. 5. new text begin REVISOR INSTRUCTION.
new text end

new text begin The revisor of statutes shall make necessary cross-reference changes and remove statutory
cross-references in Minnesota Statutes to conform with the repealer in this act. The revisor
may make technical and other necessary changes to language and sentence structure to
preserve the meaning of the text.
new text end

Sec. 6. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2020, section 256B.0943, subdivisions 8, 8a, 10, 12, and 13, new text end new text begin are
repealed.
new text end

new text begin (b) new text end new text begin Minnesota Statutes 2021 Supplement, sections 245.735, subdivisions 3, 5, and 6;
and 256B.0943, subdivisions 1, 2, 3, 4, 5, 5a, 6, 7, 9, and 11, new text end new text begin are repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

APPENDIX

Repealed Minnesota Statutes: 22-06935

245.735 CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC SERVICES.

Subd. 3.

Certified community behavioral health clinics.

(a) The commissioner shall establish a state certification process for certified community behavioral health clinics (CCBHCs) that satisfy all federal requirements necessary for CCBHCs certified under this section to be eligible for reimbursement under medical assistance, without service area limits based on geographic area or region. The commissioner shall consult with CCBHC stakeholders before establishing and implementing changes in the certification process and requirements. Entities that choose to be CCBHCs must:

(1) comply with state licensing requirements and other requirements issued by the commissioner;

(2) employ or contract for clinic staff who have backgrounds in diverse disciplines, including licensed mental health professionals and licensed alcohol and drug counselors, and staff who are culturally and linguistically trained to meet the needs of the population the clinic serves;

(3) ensure that clinic services are available and accessible to individuals and families of all ages and genders and that crisis management services are available 24 hours per day;

(4) establish fees for clinic services for individuals who are not enrolled in medical assistance using a sliding fee scale that ensures that services to patients are not denied or limited due to an individual's inability to pay for services;

(5) comply with quality assurance reporting requirements and other reporting requirements, including any required reporting of encounter data, clinical outcomes data, and quality data;

(6) provide crisis mental health and substance use services, withdrawal management services, emergency crisis intervention services, and stabilization services through existing mobile crisis services; screening, assessment, and diagnosis services, including risk assessments and level of care determinations; person- and family-centered treatment planning; outpatient mental health and substance use services; targeted case management; psychiatric rehabilitation services; peer support and counselor services and family support services; and intensive community-based mental health services, including mental health services for members of the armed forces and veterans. CCBHCs must directly provide the majority of these services to enrollees, but may coordinate some services with another entity through a collaboration or agreement, pursuant to paragraph (b);

(7) provide coordination of care across settings and providers to ensure seamless transitions for individuals being served across the full spectrum of health services, including acute, chronic, and behavioral needs. Care coordination may be accomplished through partnerships or formal contracts with:

(i) counties, health plans, pharmacists, pharmacies, rural health clinics, federally qualified health centers, inpatient psychiatric facilities, substance use and detoxification facilities, or community-based mental health providers; and

(ii) other community services, supports, and providers, including schools, child welfare agencies, juvenile and criminal justice agencies, Indian health services clinics, tribally licensed health care and mental health facilities, urban Indian health clinics, Department of Veterans Affairs medical centers, outpatient clinics, drop-in centers, acute care hospitals, and hospital outpatient clinics;

(8) be certified as mental health clinics under section 245.69, subdivision 2;

(9) comply with standards established by the commissioner relating to CCBHC screenings, assessments, and evaluations;

(10) be licensed to provide substance use disorder treatment under chapter 245G;

(11) be certified to provide children's therapeutic services and supports under section 256B.0943;

(12) be certified to provide adult rehabilitative mental health services under section 256B.0623;

(13) be enrolled to provide mental health crisis response services under sections 256B.0624 and 256B.0944;

(14) be enrolled to provide mental health targeted case management under section 256B.0625, subdivision 20;

(15) comply with standards relating to mental health case management in Minnesota Rules, parts 9520.0900 to 9520.0926;

(16) provide services that comply with the evidence-based practices described in paragraph (e); and

(17) comply with standards relating to peer services under sections 256B.0615, 256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), as applicable when peer services are provided.

(b) If a certified CCBHC is unable to provide one or more of the services listed in paragraph (a), clauses (6) to (17), the CCBHC may contract with another entity that has the required authority to provide that service and that meets the following criteria as a designated collaborating organization:

(1) the entity has a formal agreement with the CCBHC to furnish one or more of the services under paragraph (a), clause (6);

(2) the entity provides assurances that it will provide services according to CCBHC service standards and provider requirements;

(3) the entity agrees that the CCBHC is responsible for coordinating care and has clinical and financial responsibility for the services that the entity provides under the agreement; and

(4) the entity meets any additional requirements issued by the commissioner.

(c) Notwithstanding any other law that requires a county contract or other form of county approval for certain services listed in paragraph (a), clause (6), a clinic that otherwise meets CCBHC requirements may receive the prospective payment under section 256B.0625, subdivision 5m, for those services without a county contract or county approval. As part of the certification process in paragraph (a), the commissioner shall require a letter of support from the CCBHC's host county confirming that the CCBHC and the county or counties it serves have an ongoing relationship to facilitate access and continuity of care, especially for individuals who are uninsured or who may go on and off medical assistance.

(d) When the standards listed in paragraph (a) or other applicable standards conflict or address similar issues in duplicative or incompatible ways, the commissioner may grant variances to state requirements if the variances do not conflict with federal requirements for services reimbursed under medical assistance. If standards overlap, the commissioner may substitute all or a part of a licensure or certification that is substantially the same as another licensure or certification. The commissioner shall consult with stakeholders, as described in subdivision 4, before granting variances under this provision. For the CCBHC that is certified but not approved for prospective payment under section 256B.0625, subdivision 5m, the commissioner may grant a variance under this paragraph if the variance does not increase the state share of costs.

(e) The commissioner shall issue a list of required evidence-based practices to be delivered by CCBHCs, and may also provide a list of recommended evidence-based practices. The commissioner may update the list to reflect advances in outcomes research and medical services for persons living with mental illnesses or substance use disorders. The commissioner shall take into consideration the adequacy of evidence to support the efficacy of the practice, the quality of workforce available, and the current availability of the practice in the state. At least 30 days before issuing the initial list and any revisions, the commissioner shall provide stakeholders with an opportunity to comment.

(f) The commissioner shall recertify CCBHCs at least every three years. The commissioner shall establish a process for decertification and shall require corrective action, medical assistance repayment, or decertification of a CCBHC that no longer meets the requirements in this section or that fails to meet the standards provided by the commissioner in the application and certification process.

Subd. 5.

Information systems support.

The commissioner and the state chief information officer shall provide information systems support to the projects as necessary to comply with state and federal requirements.

Subd. 6.

Demonstration entities.

The commissioner may operate the demonstration program established by section 223 of the Protecting Access to Medicare Act if federal funding for the demonstration program remains available from the United States Department of Health and Human Services. To the extent practicable, the commissioner shall align the requirements of the demonstration program with the requirements under this section for CCBHCs receiving medical assistance reimbursement. A CCBHC may not apply to participate as a billing provider in both the CCBHC federal demonstration and the benefit for CCBHCs under the medical assistance program.

256B.0943 CHILDREN'S THERAPEUTIC SERVICES AND SUPPORTS.

Subdivision 1.

Definitions.

For purposes of this section, the following terms have the meanings given them.

(a) "Children's therapeutic services and supports" means the flexible package of mental health services for children who require varying therapeutic and rehabilitative levels of intervention to treat a diagnosed emotional disturbance, as defined in section 245.4871, subdivision 15, or a diagnosed mental illness, as defined in section 245.462, subdivision 20. The services are time-limited interventions that are delivered using various treatment modalities and combinations of services designed to reach treatment outcomes identified in the individual treatment plan.

(b) "Clinical trainee" means a staff person who is qualified according to section 245I.04, subdivision 6.

(c) "Crisis planning" has the meaning given in section 245.4871, subdivision 9a.

(d) "Culturally competent provider" means a provider who understands and can utilize to a client's benefit the client's culture when providing services to the client. A provider may be culturally competent because the provider is of the same cultural or ethnic group as the client or the provider has developed the knowledge and skills through training and experience to provide services to culturally diverse clients.

(e) "Day treatment program" for children means a site-based structured mental health program consisting of psychotherapy for three or more individuals and individual or group skills training provided by a team, under the treatment supervision of a mental health professional.

(f) "Standard diagnostic assessment" means the assessment described in 245I.10, subdivision 6.

(g) "Direct service time" means the time that a mental health professional, clinical trainee, mental health practitioner, or mental health behavioral aide spends face-to-face with a client and the client's family or providing covered services through telehealth as defined under section 256B.0625, subdivision 3b. Direct service time includes time in which the provider obtains a client's history, develops a client's treatment plan, records individual treatment outcomes, or provides service components of children's therapeutic services and supports. Direct service time does not include time doing work before and after providing direct services, including scheduling or maintaining clinical records.

(h) "Direction of mental health behavioral aide" means the activities of a mental health professional, clinical trainee, or mental health practitioner in guiding the mental health behavioral aide in providing services to a client. The direction of a mental health behavioral aide must be based on the client's individual treatment plan and meet the requirements in subdivision 6, paragraph (b), clause (7).

(i) "Emotional disturbance" has the meaning given in section 245.4871, subdivision 15.

(j) "Individual behavioral plan" means a plan of intervention, treatment, and services for a child written by a mental health professional or a clinical trainee or mental health practitioner under the treatment supervision of a mental health professional, to guide the work of the mental health behavioral aide. The individual behavioral plan may be incorporated into the child's individual treatment plan so long as the behavioral plan is separately communicable to the mental health behavioral aide.

(k) "Individual treatment plan" means the plan described in section 245I.10, subdivisions 7 and 8.

(l) "Mental health behavioral aide services" means medically necessary one-on-one activities performed by a mental health behavioral aide qualified according to section 245I.04, subdivision 16, to assist a child retain or generalize psychosocial skills as previously trained by a mental health professional, clinical trainee, or mental health practitioner and as described in the child's individual treatment plan and individual behavior plan. Activities involve working directly with the child or child's family as provided in subdivision 9, paragraph (b), clause (4).

(m) "Mental health certified family peer specialist" means a staff person who is qualified according to section 245I.04, subdivision 12.

(n) "Mental health practitioner" means a staff person who is qualified according to section 245I.04, subdivision 4.

(o) "Mental health professional" means a staff person who is qualified according to section 245I.04, subdivision 2.

(p) "Mental health service plan development" includes:

(1) the development, review, and revision of a child's individual treatment plan, including involvement of the client or client's parents, primary caregiver, or other person authorized to consent to mental health services for the client, and including arrangement of treatment and support activities specified in the individual treatment plan; and

(2) administering and reporting the standardized outcome measurements in section 245I.10, subdivision 6, paragraph (d), clauses (3) and (4), and other standardized outcome measurements approved by the commissioner, as periodically needed to evaluate the effectiveness of treatment.

(q) "Mental illness," for persons at least age 18 but under age 21, has the meaning given in section 245.462, subdivision 20, paragraph (a).

(r) "Psychotherapy" means the treatment described in section 256B.0671, subdivision 11.

(s) "Rehabilitative services" or "psychiatric rehabilitation services" means interventions to: (1) restore a child or adolescent to an age-appropriate developmental trajectory that had been disrupted by a psychiatric illness; or (2) enable the child to self-monitor, compensate for, cope with, counteract, or replace psychosocial skills deficits or maladaptive skills acquired over the course of a psychiatric illness. Psychiatric rehabilitation services for children combine coordinated psychotherapy to address internal psychological, emotional, and intellectual processing deficits, and skills training to restore personal and social functioning. Psychiatric rehabilitation services establish a progressive series of goals with each achievement building upon a prior achievement.

(t) "Skills training" means individual, family, or group training, delivered by or under the supervision of a mental health professional, designed to facilitate the acquisition of psychosocial skills that are medically necessary to rehabilitate the child to an age-appropriate developmental trajectory heretofore disrupted by a psychiatric illness or to enable the child to self-monitor, compensate for, cope with, counteract, or replace skills deficits or maladaptive skills acquired over the course of a psychiatric illness. Skills training is subject to the service delivery requirements under subdivision 9, paragraph (b), clause (2).

(u) "Treatment supervision" means the supervision described in section 245I.06.

Subd. 2.

Covered service components of children's therapeutic services and supports.

(a) Subject to federal approval, medical assistance covers medically necessary children's therapeutic services and supports when the services are provided by an eligible provider entity certified under and meeting the standards in this section. The provider entity must make reasonable and good faith efforts to report individual client outcomes to the commissioner, using instruments and protocols approved by the commissioner.

(b) The service components of children's therapeutic services and supports are:

(1) patient and/or family psychotherapy, family psychotherapy, psychotherapy for crisis, and group psychotherapy;

(2) individual, family, or group skills training provided by a mental health professional, clinical trainee, or mental health practitioner;

(3) crisis planning;

(4) mental health behavioral aide services;

(5) direction of a mental health behavioral aide;

(6) mental health service plan development; and

(7) children's day treatment.

Subd. 3.

Determination of client eligibility.

(a) A client's eligibility to receive children's therapeutic services and supports under this section shall be determined based on a standard diagnostic assessment by a mental health professional or a clinical trainee that is performed within one year before the initial start of service. The standard diagnostic assessment must:

(1) determine whether a child under age 18 has a diagnosis of emotional disturbance or, if the person is between the ages of 18 and 21, whether the person has a mental illness;

(2) document children's therapeutic services and supports as medically necessary to address an identified disability, functional impairment, and the individual client's needs and goals; and

(3) be used in the development of the individual treatment plan.

(b) Notwithstanding paragraph (a), a client may be determined to be eligible for up to five days of day treatment under this section based on a hospital's medical history and presentation examination of the client.

Subd. 4.

Provider entity certification.

(a) The commissioner shall establish an initial provider entity application and certification process and recertification process to determine whether a provider entity has an administrative and clinical infrastructure that meets the requirements in subdivisions 5 and 6. A provider entity must be certified for the three core rehabilitation services of psychotherapy, skills training, and crisis planning. The commissioner shall recertify a provider entity at least every three years. The commissioner shall establish a process for decertification of a provider entity and shall require corrective action, medical assistance repayment, or decertification of a provider entity that no longer meets the requirements in this section or that fails to meet the clinical quality standards or administrative standards provided by the commissioner in the application and certification process.

(b) For purposes of this section, a provider entity must meet the standards in this section and chapter 245I, as required under section 245I.011, subdivision 5, and be:

(1) an Indian health services facility or a facility owned and operated by a tribe or tribal organization operating as a 638 facility under Public Law 93-638 certified by the state;

(2) a county-operated entity certified by the state; or

(3) a noncounty entity certified by the state.

Subd. 5.

Provider entity administrative infrastructure requirements.

(a) An eligible provider entity shall demonstrate the availability, by means of employment or contract, of at least one backup mental health professional in the event of the primary mental health professional's absence.

(b) In addition to the policies and procedures required under section 245I.03, the policies and procedures must include:

(1) fiscal procedures, including internal fiscal control practices and a process for collecting revenue that is compliant with federal and state laws; and

(2) a client-specific treatment outcomes measurement system, including baseline measures, to measure a client's progress toward achieving mental health rehabilitation goals.

(c) A provider entity that uses a restrictive procedure with a client must meet the requirements of section 245.8261.

Subd. 5a.

Background studies.

The requirements for background studies under section 245I.011, subdivision 4, paragraph (d), may be met by a children's therapeutic services and supports services agency through the commissioner's NETStudy system as provided under sections 245C.03, subdivision 7, and 245C.10, subdivision 8.

Subd. 6.

Provider entity clinical infrastructure requirements.

(a) To be an eligible provider entity under this section, a provider entity must have a clinical infrastructure that utilizes diagnostic assessment, individual treatment plans, service delivery, and individual treatment plan review that are culturally competent, child-centered, and family-driven to achieve maximum benefit for the client. The provider entity must review, and update as necessary, the clinical policies and procedures every three years, must distribute the policies and procedures to staff initially and upon each subsequent update, and must train staff accordingly.

(b) The clinical infrastructure written policies and procedures must include policies and procedures for meeting the requirements in this subdivision:

(1) providing or obtaining a client's standard diagnostic assessment, including a standard diagnostic assessment. When required components of the standard diagnostic assessment are not provided in an outside or independent assessment or cannot be attained immediately, the provider entity must determine the missing information within 30 days and amend the child's standard diagnostic assessment or incorporate the information into the child's individual treatment plan;

(2) developing an individual treatment plan;

(3) developing an individual behavior plan that documents and describes interventions to be provided by the mental health behavioral aide. The individual behavior plan must include:

(i) detailed instructions on the psychosocial skills to be practiced;

(ii) time allocated to each intervention;

(iii) methods of documenting the child's behavior;

(iv) methods of monitoring the child's progress in reaching objectives; and

(v) goals to increase or decrease targeted behavior as identified in the individual treatment plan;

(4) providing treatment supervision plans for staff according to section 245I.06. Treatment supervision does not include the authority to make or terminate court-ordered placements of the child. A treatment supervisor must be available for urgent consultation as required by the individual client's needs or the situation;

(5) meeting day treatment program conditions in items (i) and (ii):

(i) the treatment supervisor must be present and available on the premises more than 50 percent of the time in a provider's standard working week during which the supervisee is providing a mental health service; and

(ii) every 30 days, the treatment supervisor must review and sign the record indicating the supervisor has reviewed the client's care for all activities in the preceding 30-day period;

(6) meeting the treatment supervision standards in items (i) and (ii) for all other services provided under CTSS:

(i) the mental health professional is required to be present at the site of service delivery for observation as clinically appropriate when the clinical trainee, mental health practitioner, or mental health behavioral aide is providing CTSS services; and

(ii) when conducted, the on-site presence of the mental health professional must be documented in the child's record and signed by the mental health professional who accepts full professional responsibility;

(7) providing direction to a mental health behavioral aide. For entities that employ mental health behavioral aides, the treatment supervisor must be employed by the provider entity or other provider certified to provide mental health behavioral aide services to ensure necessary and appropriate oversight for the client's treatment and continuity of care. The staff giving direction must begin with the goals on the individual treatment plan, and instruct the mental health behavioral aide on how to implement therapeutic activities and interventions that will lead to goal attainment. The staff giving direction must also instruct the mental health behavioral aide about the client's diagnosis, functional status, and other characteristics that are likely to affect service delivery. Direction must also include determining that the mental health behavioral aide has the skills to interact with the client and the client's family in ways that convey personal and cultural respect and that the aide actively solicits information relevant to treatment from the family. The aide must be able to clearly explain or demonstrate the activities the aide is doing with the client and the activities' relationship to treatment goals. Direction is more didactic than is supervision and requires the staff providing it to continuously evaluate the mental health behavioral aide's ability to carry out the activities of the individual treatment plan and the individual behavior plan. When providing direction, the staff must:

(i) review progress notes prepared by the mental health behavioral aide for accuracy and consistency with diagnostic assessment, treatment plan, and behavior goals and the staff must approve and sign the progress notes;

(ii) identify changes in treatment strategies, revise the individual behavior plan, and communicate treatment instructions and methodologies as appropriate to ensure that treatment is implemented correctly;

(iii) demonstrate family-friendly behaviors that support healthy collaboration among the child, the child's family, and providers as treatment is planned and implemented;

(iv) ensure that the mental health behavioral aide is able to effectively communicate with the child, the child's family, and the provider;

(v) record the results of any evaluation and corrective actions taken to modify the work of the mental health behavioral aide; and

(vi) ensure the immediate accessibility of a mental health professional, clinical trainee, or mental health practitioner to the behavioral aide during service delivery;

(8) providing service delivery that implements the individual treatment plan and meets the requirements under subdivision 9; and

(9) individual treatment plan review. The review must determine the extent to which the services have met each of the goals and objectives in the treatment plan. The review must assess the client's progress and ensure that services and treatment goals continue to be necessary and appropriate to the client and the client's family or foster family.

Subd. 7.

Qualifications of individual and team providers.

(a) An individual or team provider working within the scope of the provider's practice or qualifications may provide service components of children's therapeutic services and supports that are identified as medically necessary in a client's individual treatment plan.

(b) An individual provider must be qualified as a:

(1) mental health professional;

(2) clinical trainee;

(3) mental health practitioner;

(4) mental health certified family peer specialist; or

(5) mental health behavioral aide.

(c) A day treatment team must include at least one mental health professional or clinical trainee and one mental health practitioner.

Subd. 8.

Required preservice and continuing education.

(a) A provider entity shall establish a plan to provide preservice and continuing education for staff. The plan must clearly describe the type of training necessary to maintain current skills and obtain new skills and that relates to the provider entity's goals and objectives for services offered.

(b) A provider that employs a mental health behavioral aide under this section must require the mental health behavioral aide to complete 30 hours of preservice training. The preservice training must include parent team training. The preservice training must include 15 hours of in-person training of a mental health behavioral aide in mental health services delivery and eight hours of parent team training. Curricula for parent team training must be approved in advance by the commissioner. Components of parent team training include:

(1) partnering with parents;

(2) fundamentals of family support;

(3) fundamentals of policy and decision making;

(4) defining equal partnership;

(5) complexities of the parent and service provider partnership in multiple service delivery systems due to system strengths and weaknesses;

(6) sibling impacts;

(7) support networks; and

(8) community resources.

(c) A provider entity that employs a mental health practitioner and a mental health behavioral aide to provide children's therapeutic services and supports under this section must require the mental health practitioner and mental health behavioral aide to complete 20 hours of continuing education every two calendar years. The continuing education must be related to serving the needs of a child with emotional disturbance in the child's home environment and the child's family.

(d) The provider entity must document the mental health practitioner's or mental health behavioral aide's annual completion of the required continuing education. The documentation must include the date, subject, and number of hours of the continuing education, and attendance records, as verified by the staff member's signature, job title, and the instructor's name. The provider entity must keep documentation for each employee, including records of attendance at professional workshops and conferences, at a central location and in the employee's personnel file.

Subd. 8a.

Level II mental health behavioral aide.

The commissioner of human services, in collaboration with children's mental health providers and the Board of Trustees of the Minnesota State Colleges and Universities, shall develop a certificate program for level II mental health behavioral aides.

Subd. 9.

Service delivery criteria.

(a) In delivering services under this section, a certified provider entity must ensure that:

(1) the provider's caseload size should reasonably enable the provider to play an active role in service planning, monitoring, and delivering services to meet the client's and client's family's needs, as specified in each client's individual treatment plan;

(2) site-based programs, including day treatment programs, provide staffing and facilities to ensure the client's health, safety, and protection of rights, and that the programs are able to implement each client's individual treatment plan; and

(3) a day treatment program is provided to a group of clients by a team under the treatment supervision of a mental health professional. The day treatment program must be provided in and by: (i) an outpatient hospital accredited by the Joint Commission on Accreditation of Health Organizations and licensed under sections 144.50 to 144.55; (ii) a community mental health center under section 245.62; or (iii) an entity that is certified under subdivision 4 to operate a program that meets the requirements of section 245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475. The day treatment program must stabilize the client's mental health status while developing and improving the client's independent living and socialization skills. The goal of the day treatment program must be to reduce or relieve the effects of mental illness and provide training to enable the client to live in the community. The program must be available year-round at least three to five days per week, two or three hours per day, unless the normal five-day school week is shortened by a holiday, weather-related cancellation, or other districtwide reduction in a school week. A child transitioning into or out of day treatment must receive a minimum treatment of one day a week for a two-hour time block. The two-hour time block must include at least one hour of patient and/or family or group psychotherapy. The remainder of the structured treatment program may include patient and/or family or group psychotherapy, and individual or group skills training, if included in the client's individual treatment plan. Day treatment programs are not part of inpatient or residential treatment services. When a day treatment group that meets the minimum group size requirement temporarily falls below the minimum group size because of a member's temporary absence, medical assistance covers a group session conducted for the group members in attendance. A day treatment program may provide fewer than the minimally required hours for a particular child during a billing period in which the child is transitioning into, or out of, the program.

(b) To be eligible for medical assistance payment, a provider entity must deliver the service components of children's therapeutic services and supports in compliance with the following requirements:

(1) psychotherapy to address the child's underlying mental health disorder must be documented as part of the child's ongoing treatment. A provider must deliver, or arrange for, medically necessary psychotherapy, unless the child's parent or caregiver chooses not to receive it. When a provider delivering other services to a child under this section deems it not medically necessary to provide psychotherapy to the child for a period of 90 days or longer, the provider entity must document the medical reasons why psychotherapy is not necessary. When a provider determines that a child needs psychotherapy but psychotherapy cannot be delivered due to a shortage of licensed mental health professionals in the child's community, the provider must document the lack of access in the child's medical record;

(2) individual, family, or group skills training is subject to the following requirements:

(i) a mental health professional, clinical trainee, or mental health practitioner shall provide skills training;

(ii) skills training delivered to a child or the child's family must be targeted to the specific deficits or maladaptations of the child's mental health disorder and must be prescribed in the child's individual treatment plan;

(iii) the mental health professional delivering or supervising the delivery of skills training must document any underlying psychiatric condition and must document how skills training is being used in conjunction with psychotherapy to address the underlying condition;

(iv) skills training delivered to the child's family must teach skills needed by parents to enhance the child's skill development, to help the child utilize daily life skills taught by a mental health professional, clinical trainee, or mental health practitioner, and to develop or maintain a home environment that supports the child's progressive use of skills;

(v) group skills training may be provided to multiple recipients who, because of the nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from interaction in a group setting, which must be staffed as follows:

(A) one mental health professional, clinical trainee, or mental health practitioner must work with a group of three to eight clients; or

(B) any combination of two mental health professionals, clinical trainees, or mental health practitioners must work with a group of nine to 12 clients;

(vi) a mental health professional, clinical trainee, or mental health practitioner must have taught the psychosocial skill before a mental health behavioral aide may practice that skill with the client; and

(vii) for group skills training, when a skills group that meets the minimum group size requirement temporarily falls below the minimum group size because of a group member's temporary absence, the provider may conduct the session for the group members in attendance;

(3) crisis planning to a child and family must include development of a written plan that anticipates the particular factors specific to the child that may precipitate a psychiatric crisis for the child in the near future. The written plan must document actions that the family should be prepared to take to resolve or stabilize a crisis, such as advance arrangements for direct intervention and support services to the child and the child's family. Crisis planning must include preparing resources designed to address abrupt or substantial changes in the functioning of the child or the child's family when sudden change in behavior or a loss of usual coping mechanisms is observed, or the child begins to present a danger to self or others;

(4) mental health behavioral aide services must be medically necessary treatment services, identified in the child's individual treatment plan and individual behavior plan, and which are designed to improve the functioning of the child in the progressive use of developmentally appropriate psychosocial skills. Activities involve working directly with the child, child-peer groupings, or child-family groupings to practice, repeat, reintroduce, and master the skills defined in subdivision 1, paragraph (t), as previously taught by a mental health professional, clinical trainee, or mental health practitioner including:

(i) providing cues or prompts in skill-building peer-to-peer or parent-child interactions so that the child progressively recognizes and responds to the cues independently;

(ii) performing as a practice partner or role-play partner;

(iii) reinforcing the child's accomplishments;

(iv) generalizing skill-building activities in the child's multiple natural settings;

(v) assigning further practice activities; and

(vi) intervening as necessary to redirect the child's target behavior and to de-escalate behavior that puts the child or other person at risk of injury.

To be eligible for medical assistance payment, mental health behavioral aide services must be delivered to a child who has been diagnosed with an emotional disturbance or a mental illness, as provided in subdivision 1, paragraph (a). The mental health behavioral aide must implement treatment strategies in the individual treatment plan and the individual behavior plan as developed by the mental health professional, clinical trainee, or mental health practitioner providing direction for the mental health behavioral aide. The mental health behavioral aide must document the delivery of services in written progress notes. Progress notes must reflect implementation of the treatment strategies, as performed by the mental health behavioral aide and the child's responses to the treatment strategies; and

(5) mental health service plan development must be performed in consultation with the child's family and, when appropriate, with other key participants in the child's life by the child's treating mental health professional or clinical trainee or by a mental health practitioner and approved by the treating mental health professional. Treatment plan drafting consists of development, review, and revision by face-to-face or electronic communication. The provider must document events, including the time spent with the family and other key participants in the child's life to approve the individual treatment plan. Medical assistance covers service plan development before completion of the child's individual treatment plan. Service plan development is covered only if a treatment plan is completed for the child. If upon review it is determined that a treatment plan was not completed for the child, the commissioner shall recover the payment for the service plan development.

Subd. 10.

Service authorization.

Children's therapeutic services and supports are subject to authorization criteria and standards published by the commissioner according to section 256B.0625, subdivision 25.

Subd. 11.

Documentation and billing.

A provider entity must document the services it provides under this section. The provider entity must ensure that documentation complies with Minnesota Rules, parts 9505.2175 and 9505.2197. Services billed under this section that are not documented according to this subdivision shall be subject to monetary recovery by the commissioner. Billing for covered service components under subdivision 2, paragraph (b), must not include anything other than direct service time.

Subd. 12.

Excluded services.

The following services are not eligible for medical assistance payment as children's therapeutic services and supports:

(1) service components of children's therapeutic services and supports simultaneously provided by more than one provider entity unless prior authorization is obtained;

(2) treatment by multiple providers within the same agency at the same clock time;

(3) children's therapeutic services and supports provided in violation of medical assistance policy in Minnesota Rules, part 9505.0220;

(4) mental health behavioral aide services provided by a personal care assistant who is not qualified as a mental health behavioral aide and employed by a certified children's therapeutic services and supports provider entity;

(5) service components of CTSS that are the responsibility of a residential or program license holder, including foster care providers under the terms of a service agreement or administrative rules governing licensure; and

(6) adjunctive activities that may be offered by a provider entity but are not otherwise covered by medical assistance, including:

(i) a service that is primarily recreation oriented or that is provided in a setting that is not medically supervised. This includes sports activities, exercise groups, activities such as craft hours, leisure time, social hours, meal or snack time, trips to community activities, and tours;

(ii) a social or educational service that does not have or cannot reasonably be expected to have a therapeutic outcome related to the client's emotional disturbance;

(iii) prevention or education programs provided to the community; and

(iv) treatment for clients with primary diagnoses of alcohol or other drug abuse.

Subd. 13.

Exception to excluded services.

Notwithstanding subdivision 12, up to 15 hours of children's therapeutic services and supports provided within a six-month period to a child with severe emotional disturbance who is residing in a hospital; a residential treatment facility licensed under Minnesota Rules, parts 2960.0580 to 2960.0690; a psychiatric residential treatment facility under section 256B.0625, subdivision 45a; a regional treatment center; or other institutional group setting or who is participating in a program of partial hospitalization are eligible for medical assistance payment if part of the discharge plan.